Malignant solid tumour, HIV infection and tuberculosis in children: an unholy triad.

INTRODUCTION: Co-morbidities introduce confounding variables into investigational protocols and complicate both diagnosis and management of children with malignant solid tumours. Such patients who are coincidentally HIV infected and who also have pulmonary or abdominal tuberculosis pose a particular challenge. AIM: The purpose of this report is to describe the diagnostic and management difficulties encountered in a small cadre of 18 HIV-infected children with solid tumours presenting to the Department of Paediatric Surgery. METHOD: A retrospective descriptive study of HIV-infected children with malignant solid tumours. RESULTS: 18 HIV-infected children were identified with a variety of primary tumours. 11 children had confirmed pulmonary or abdominal tuberculosis and in 4 the diagnosis was suspected. Neoadjuvant chemotherapy was used when possible to provide a window of opportunity to investigate co-morbidity and improve health status, inter alia, improving the patients' nutritional status. FDG-PET scanning proved unreliable in discriminating between malignant and inflammatory pathology. Overall survival was 33%. CONCLUSION: The coincidence of malignancy, HIV infection and tuberculosis carries a high mortality independent of the primary tumour type.

The scintigraphic evaluation of the pulmonary perfusion pattern of dogs hospitalised with babesiosis.

The possibility of coagulopathy in Babesia canis rossi infections in the canine patient has been suggested in the literature, but minimal work has been done to evaluate the clinicopathological nature of it in further detail. Pulmonary thromboembolism (PTE) has not yet been implicated in canine babesiosis (CB), but may also be one of the causes of the sudden dyspnoea and tachypnoea that are frequently seen in complicated CB patients. The objective of this study was to prospectively evaluate the scintigraphic pulmonary perfusion pattern in hospitalised dogs with babesiosis in an attempt to ascertain whether a scintigraphic pattern consistent with clinically relevant PTE does indeed occur in these patients. The study consisted of a normal control group of 9 mature healthy Beagle dogs (group 1) and a Babesia group with 14 dogs of a variety of breeds that were naturally infected with Babesia (group 2). Pulmonary perfusion scintigraphy was performed after making thoracic radiographs and performing a blood gas analysis in both groups. The scintigraphic images were visually inspected for changes suggestive of PTE, but not a single dog in group 2 had pleural-based, wedge-shaped perfusion defects which would have resulted in a high probability for clinically relevant PTE. The scintigraphic pulmonary perfusion pattern demonstrated was not significantly different between the 2 groups (P = 1.00).